Medical Policy
Reviewed: Andrew Rojas 9/9/16
Next Review: September 2017
Cathedral Primary School endeavours to ensure that all its pupils achieve success in their academic work, social relationships and day-to-day experiences at school. It is an inclusive community that aims to support and welcome pupils with medical conditions.
All children will experience illness in the course of their school careers, most commonly transient self-limiting infections, but some will have more chronic or longer-term medical needs that will require additional support at school to ensure they have full access to the curriculum and to minimise the impact of their medical conditions.
Staff working with pupils who have specific medical needs should understand the nature of children’s medical problems and will endeavour to work with the family and other professionals to best support the individuals concerned.
Managing medicines
On occasion, children may need to take medicines whilst in school. Some children are on long term regular medication for chronic conditions or may need to take emergency/as needed medication to treat a change in their underlying condition.
There are cases where the responsibility for administering medicine can and should rest with the child. Where parents request the school to exercise a degree of supervision or to administer the medicine, the situation is more complicated. In such cases, staff should consult the headteacher and any practical and organisational implications need to be addressed prior to assuming responsibility for this.
General Principles
The administration of medicine is the responsibility of parents and carers. There is no absolute requirement on teachers or support staff to administer medicines. However, where they volunteer to do so, guidelines are helpful.
Short-term illness
· Children who are suffering from short-term ailments and who are clearly unwell should not be in school and headteachers are within their rights to ask parents/carers to keep them at home.
· We discourage parents from sending children to school with non-prescribed medicines as mention in Supporting Pupils at School with Medical Conditions; page 20 paragraph 5
https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/522337/Guidance_on_infection_control_in_schools.pdf
· There are recommended times away from school to limited the spread of infectious disease. Please see Public Health England guidelines for this https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/353953/Guidance_on_infection_control_in_schools_11_Sept.pdf
· Note, children who have had sickness and/or diarrhoea should be kept off school until 48 hours symptom-free.
Chronic illness/disability
It may be necessary for children with long term conditions to take prescribed medicines during school hours.
Many health advisers encourage children to take control of their medical condition, including taking responsibility for managing their medical care (with help,) from very young. This can include self-administration of medicines eg. using an inhaler or giving own insulin injections. We support this practice wherever appropriate.
Where young children or those with special educational needs and or disabilities require medication, adult support will be needed. Whilst responsibility for the medical care of children rest with parents, carers and their health professionals, it may not be feasible for these individuals to come to school to administer medicines.
Acute illness
The teaching profession has a general duty of care towards children in schools. Legally this duty cannot require teachers to administer medicines, but it is expected that teachers react promptly and reasonably if a child is taken suddenly ill. In these cases, clear procedures must be followed, particularly in life threatening situations.
Good practice
Documentation:
· Where medicines are to be administered at school, it is important that a written instruction should have been received from the doctor, specifying:
1. Name and class of the child
2. Medication involved
3. Circumstances medication should be administered
4. Frequency and level of dosage
· Use a copy of the model form (see Appendix C)
· For more serious or chronic conditions, including allergies that require the potential use of an epipen, we require an Individual Health Care Plan (IHCP) from a child’s doctor stating exactly what needs to be given and when. This is usually requested via the school nurse service and written with the parent/carer. (See Appendix D)
Training: teachers and support staff should receive appropriate training and guidance via the School Health Service for non-routine administrations.
School Nurse: Tel: 02030498616 / 02030494728
Email:
Giving regular medicines:
· We encourage parents whose child is taking medication three times a day (or ‘TDS’), to give it before school, after school and at bedtime. If a doctor has specified that one of the doses should be given at lunchtime and the parent/carer is unable to administer the dose, follow standard practice (see below).
· If medicine has to be taken four times a day (or ‘q.d.s.’) and a lunchtime dose is necessary, the standard practice (see below) is followed.
Standard Practice
1. Ask the Parent/Carer to complete a Medicine Administration request form. (AppendixC)
2. Refer to this form prior to giving the medicine.
3. Check the child’s name on the form and the medicine.
4. Check the prescribed dose.
5. Check the expiry date.
6. Check the prescribed frequency of the medicine.
7. Measure out the prescribed dose (parents should provide measuring spoons/syringes). If the child is old enough, they can measure the medicine.
8. Check the child’s name again and administer the medicine.
9. Complete and sign the Administration of Medicine Record Book when the child has taken the medicine and the child should counter-sign.
10. If uncertain, DO NOT give – check first with parents or doctor.
11. If a child refuses medication, record and inform parents as soon as possible.
Medicine storage
It is the responsibility of the headteacher to ensure safe storage of medicines. All medicines should be kept in the container supplied which should be clearly labelled with the child’s name, another identifier (such as date of birth) and instruction for usage. All children with medical conditions should have easy access to their emergency medication. Some medicines (eg liquid antibiotics, insulin) require refrigeration – but must not be frozen. These should be kept in suitable additional and airtight containers (eg Tupperware boxes) and marked ‘Medicines’.
Medicine disposal
Parents are asked to collect out-of-date medication. If this does not occur, medication should be taken to a pharmacy for disposal. A named member of staff is responsible for checking dates of medication and arranging disposal if any have expired. This check should occur three times a year and be documented. Sharps boxes are used to dispose of needles. These can be obtained on prescription. They should be stored in a locked cupboard. Collection of sharps boxes is arranged with the local authority’s environmental services.
General medical issues
Record keeping
· Enrolment forms: should highlight any health condition
· Individual Healthcare plans: for children with medical conditions giving details of individual children’s medical needs at school. These needed to be updated after a medical emergency or if there is a change in treatment etc. and should be reviewed at least annually. They should be kept in a secure location but specified members of staff (agreed by parents) should have access to to copies. All staff must protect a pupil’s confidentiality.
· Centralised register of children with medical needs
· Request to administer medicines at school
· Log of training relevant to medical conditions
Medi-alerts (bracelets/necklaces alerting others to a medical conditions)
As with normal jewellery, these items are a potential source of injury in games or some practical activities and should be temporarily removed or covered with sweatbands for these sessions.
Impaired mobility
Providing the GP or hospital consultant has given approval, children can attend school with plaster casts or crutches. There will be obvious restrictions on games and on some practical work to protect the child (or others). This includes outside play. Some relaxation of normal routine in relation to times of attendance or movement around the school may need to be made in the interests of safety.
Off-Site visits
Take a First Aid kit whenever children are taken off-site. Buckets and towels, in case of sickness on a journey, are also sensible precautions.
All staff attending off-site visits are aware of any pupils with medical conditions on the visit. They should receive information about the type of condition, what to do in an emergency and any other additional medication or equipment necessary.
Employee’s medicines
Staff and other employees may need to bring their own medicine into school. They have clear personal responsibility to ensure that their medication is not accessible to children.
Staff protection
“Universal precautions” and common sense hygiene precautions will minimise the risk of infection when contact with blood or other bodily fluids is unavoidable.
· Always wear gloves.
· Wash your hands before and after administering first aid and medicines
· Use the hand gel provided.
Appendix A – Medicines likely to be brought into or used at schools
Non-prescribed medicines
Parent Supplied - This should be discouraged as school cannot take responsibility for such medicines.
School Supplied – In some circumstances (e.g. Asthma) it may be appropriate for the school to administer medicine. The parent will be contacted and permission sort, the dose should be recorded.
Prescribed medicines
Antibiotics
A child taking antibiotics can recover quickly and be well enough to attend school, but it is essential that the full prescribed course of treatment is completed to prevent relapse, possible complications and bacterial resistance.
Inhalers
A child with asthma may have inhaler(s) which may need to be used regularly or before exercise, or when the child becomes wheezy. Most commonly, blue salbutamol inhalers (“relievers”) are used to relieve symptoms and brown steroid inhalers (“preventers”) are used to prevent exacerbations and control the severity of the illness.
If the school and the parent feel that the child is capable and responsible, the child should look after and carry his/her own inhaler marked with his/her name. Cases should be considered individually after consulting with parents, the child’s doctor or school nurse as appropriate.
Enzyme additives
Children with cystic fibrosis may require added enzymes to ensure that they are able to digest their food. They are usually prescribed pancreatic supplements (eg Creon) and these must be taken with food. Children may need several capsules at a time. They are entirely safe if taken accidentally by another child.
Maintenance drugs
A child may be on medication (e.g. insulin) that requires a dose during the school day.
External Agency School Support
Many of the relevant medical charities have developed resources to support school looking after children with chronic medical problems.
Asthma UK https://www.asthma.org.uk/advice/resources/#schools
Cystic fibrosis trust http://www.cftrust.org.uk/
Diabetes UK http://www.diabetes.org.uk/Information-for-parents/Living-with-diabetes-new/School/
Epilepsy Action http://www.epilepsy.org.uk/info/education
The Anaphylaxis Campaign http://www.anaphylaxis.org.uk/schools/schools-help/
Appendix B – Non-routine administration of medicines
Any request for ‘Unusual Administration’ of medicine or treatment should be referred to the school nurse for advice.
Conditions requiring emergency action
As a matter of routine, all schools must have a clear procedure for summoning an ambulance in an emergency (Appendix E).
Some life-threatening conditions may require immediate treatment and some staff may volunteer to stand-by to administer these medicines in an emergency. If they do, they must receive professional training and guidance via the School Health Services.
If the trained member of staff is absent, immediate contact with the parent needs to be made to agree alternative arrangements.
Medicines for these purposes should only be held where there is an individual protocol for the child concerned that has been written up for the school by a doctor.
Examples of these conditions follow – but should be more fully explained during training and in the individual’s protocol:
1. Anaphylaxis: (acute allergic reaction)
A very small number of people are particularly sensitive to particular substances eg bee sting, nuts and require an immediate injection of adrenaline. This is life-saving.
2. Diabetic hypoglycaemia
Blood sugar control can be difficult in diabetics, and blood sugar levels may drop to a very low level causing a child to become confused, aggressive or even unconscious. If the child does not respond to the dextrose tablets they carry, or to other foods/drinks containing sugar, Hypostop (a sugar containing gel rubbed into the gums) or an injection of Glucagon may be required.
Appendix C - parental agreement for setting to administer medicine
The school/setting will not give your child medicine unless you complete and sign this form, and the school or setting has a policy that the staff can administer medicine.
Date for review to be initiated byName of school/setting
Name of child
Date of birth
Group/class/form
Medical condition or illness
Medicine
Name/type of medicine
(as described on the container)
Expiry date
Dosage and method
Timing
Special precautions/other instructions
Are there any side effects that the school/setting needs to know about?
Self-administration – y/n
Procedures to take in an emergency
NB: Medicines must be in the original container as dispensed by the pharmacy
Contact Details
Name
Daytime telephone no.
Relationship to child
Address
I understand that I must deliver the medicine personally to / [agreed member of staff]
The above information is, to the best of my knowledge, accurate at the time of writing and I give consent to school/setting staff administering medicine in accordance with the school/setting policy. I will inform the school/setting immediately, in writing, if there is any change in dosage or frequency of the medication or if the medicine is stopped.
Signature(s)______Date:______
Appendix D: Individual Healthcare Plan
Name of school/settingChild’s name
Group/class/form
Date of birth
Child’s address
Medical diagnosis or condition
Date
Review date
Family Contact Information
Name
Phone no. (work)
(home)
(mobile)
Name
Relationship to child
Phone no. (work)
(home)
(mobile)
Clinic/Hospital Contact
Name
Phone no.
G.P.
Name
Phone no.
Who is responsible for providing support in school
Describe medical needs and give details of child’s symptoms, triggers, signs, treatments, facilities, equipment or devices, environmental issues etc
Name of medication, dose, method of administration, when to be taken, side effects, contra-indications, administered by/self-administered with/without supervision